ObjectiveTo evaluate the diagnosis and treatment of postoperative pulmonary embolism(PE). MethodsWe retrospectively analyzed clinical manifestations,diagnosis,treatment and prognosis of 51 postoperative PE. Results36 PE (70.59％ ) developed after orthopaedic surgery or with malignant tumors within 1 week after surgery.Dyspnea or chest distress was the most common symptoms.Sudden death was common in patients with PE.Problems in diagnosis of PE included:poor assessment of deep vein thrombosis(DVT) before operation,and the value of beside echocardiography in the diagnosis of patients with suspected high-risk PE was not fully recognized. Twenty-three PE cases received only anticogulant treatment.Intravenous thrombolysis or percutaneous interventional techniques were undertaken in 3 each cases.Cardiopulmonary resuscitation(CPR) simply after sudden death due to postoperative PE was often unsuccessful.ConclusionsPostoperative PE is a common cause of death,currently available measures are often ineffective.The key lies in prevention especially in those of high-risk PE or suspected non-high-risk PE.

Objective To analyze the clinical characteristics of suspected acute aortic dissection with ST-segment elevation detected by inferior leads in order to avoid the misdiagnosis of acute aortic dissection facilitating an appropriate treatment strategy carried out in time.Methods A total of 14 patients with suspected acute aortic dissection with ST-segment elevation detected by inferior leads were enrolled.Their clinical presentation,ECG features,imaging findings,laboratory testing,coronary angiography results, treatment and outcome were retrospectively analyzed.Results Clinical characteristics of suspected acute aortic dissection with ST-segment elevation detected by inferior leads suggested that hypertension as a single risk factor accounted for 79%.The patients with normal blood pressure or high blood pressure in emergency visits accounted for 86%.The amplitude of ST elevation in lead Ⅲ was greater than that in lead Ⅱ,and lead Ⅲ accompanied with ST elevation in lead V1 or V4R accounted for 86%.Significantly elevated D-dimer >2 000 ng/mL was found in those patients.Coronary angiography showed that the opening of coronary artery not seen,normal coronary arteries or a simple right coronary artery proximal lesion.Transesophageal echocardiography and computed tomography angiography were used to identify the diagnosis with 100%accuracy.The mortality rate of this group was 50%.Conclusions Patients with acute aortic dissection evidenced by ST-segment elevation detected by inferior leads are in critical setting of high mortality. Emergency surgical treatment can significantly improve the survival rate of patients.

Objective To investigate the risk factors affecting the mortality in patients with severe chest trauma (SCT).Methods A total of 777 patients with SCT (AIS≥ 3) treated at Chongqing Emergency Medical Center from January 2006 to April 2009 were involved for retrospective study.Multivariate stepwise logistic regression analysis was used to analyze 15 possible risk factors affecting their mortality.Results The factors affecting mortality in patients with SCT included hemorrhagic shock (X6,B =1.710,OR =1.291,P＜0.01),multiple organ dysfunction syndrome (MODS) (X7,B=3.453,OR =1.028,P＜0.01 ),pulmonary infection ( X9,B =2.396,OR=10.941,P ＜ 0.01 ),abdominal organ injury (X11,B=1.542,OR=1.210,P＜0.01) and thoracic AIS ≥3 (X14,B =0.487,OR =1.622,P＜0.01 ).While the protective factors affecting mortality in patients with SCT contained age ≤60 years old (X1,B =-0.035,OR =0.962,P＜0.05) and GCS≥12 (X13,B=- 0.635,OR=0.530,P＜0.05).Conclusions The age,posttraumatic complications (hemorrhagic shock,MODS,pulmonary infection)and accurate diagnosis and evaluation of trauma severity are the related factors to predict the prognosis.Development of effective treatment measures based on these risk factors plays a key role in the survival rate of patients with SCT.

Objective To analyze the complications of total proctocolectomy with ileal pouch-anal anastomosis (TPC-IPAA) in treatment of severe or refractory ulcerative colitis (UC).Methods The retrospective cross-sectional study was conducted.The clinical data of 67 patients with severe or refractory UC who underwent TPC-IPAA in the Xinhua Hospital Affiliated to Shanghai Jiaotong University from February 2008 to October 2015 were collected.All the patients received open and laparoscopy-assisted TPC-IPAA,and two-stage or three-stage surgery was performed according to the patients' conditions.Observation indicators:(1) treatment and follow-up situations,(2) short-term complications after TPC-IPAA,(3) long-term complications after TPC-IPAA.The follow-up using telephone interview and outpatient examination was performed to detect the quality of postoperative life in patients and occurrence of complications up to July 2016.Measurement data with skewed distribution were described as M (range).The comparison of quality of pre-and post-operative life in patients was done using the paired t test.Results (1) Treatment and follow-up situations:all the 67 patients received successful surgery,including 45 with two-stage surgery and 22 with three-stage surgery.Thirty-seven patients underwent open surgery and 30 underwent laparoscopic surgery.The average frequency of postoperative daily defecation,average scores of quality of pre-and post-operative lifes were 5.6,0.47 and 0.67,respectively,with a statistically significant difference between preoperative indicators and postoperative indicators (t =-4.80,P ＜ 0.05).All the 67 patients were followed up for a median time of 4.6 years (range,1.0-8.4 years).(2) Short-term complications after TPC-IPAA:Of 67 patients,10 had short-term complications (some patients with multiple complications).One patient was complicated with presacral abscess secondary to sinus formation and then was cured by topical incision of sinus under colonoscopy.Five patients were complicated with anastomotic site-related complications of TPCIPAA,and 1 with pouch-anal anastomotic fistula combined with presacral abscess underwent drainage with ileostomy and didn't undergo stoma reversion of ileum.Two patients with fistula at the top of pouch were improved by surgery and repair.Of 2 patients with pouch-vagina fistula,1 underwent resection of pouch stump-vagina fistula and then were cured,and the space between pouch stump and posterior fornix was filled with a free greater omentum flap and temporary ileal bypass was simultaneously conducted.The other patient received twice transanal vaginal fistula repairs with advancement flap,and unclosed fistula was confirmed by angiography,with a clinical symptomatic relief.Eight patients with wound infection received actively dressing change after discharge,and no wound dehiscence was occurred.(3) Long-term complications after TPC-IPAA:28 of 67 patients had long-term complications.Twelve patients with intestinal obstruction underwent conservative treatments of gastrointestinal decompression,anti-inflammatory with corticosteroid and anti-infection with antibiotic,without the occurrence of severe intestinal perforation and prognosis needing surgical intervention,including 9 undergoing open TPC-IPAA and 3 undergoing laparoscopic TPC-IPAA.Thirteen patients with postoperative pouchitis received the conservative treatment of mesalazine.Three patients with failed pouch underwent small intestine permanent colostomy,including 2 with secondary pouch Crohn's disease and 1 with severe pouchitis.Conclusions TPC-IPAA is safe and effective in treatment of UC,with a lower incidence of complications.Anastomotic site-related complication of TPC-IPAA is the main short-term complication.And in the long-term complications,pouchitis is the most,followed it is intestine obstruction.

Objective To observe the effects of Pinggan Jiangya Capsule on renin activity (RA) and angiotensinⅡ (AngⅡ) of spontaneously hypertensive rats. Methods Pinggan Jiangya Capsule was administered to male SHRs as treatment group (n=10), and equal volume of normal saline was administered to normal control WKY rats group(n=10) or SHR as model group(n=10) respectively for 12 weeks intragastrically. RA and AngⅡ level were measured by radio-immunoassay. Results The blood pressure decreased significantly after treatment with Pinggan Jiangya Capsule for 12 weeks(P

AIM: To establish a new human endometial carcinoma cell line for basic and clinical study. METHODS: The minced tumor tissues were inoculated subcutaneously into the back of nude mice. After forming solid tumor, the mice were killed and the transplant was taken out for primery culture. RESULTS: The established cell line was maintained by serial passages, named EAC. EAC cell line grew rapidly,steadily, and it had similar microscopic morphology to adenocarcinoma cell. Chromosome analysis reveal EAC chromosome counts ranging in hyperdiploid. The expression of ER, PR, P53, MDM2 were negative by SP immunohistochemistry. Tumorigenicity of EAC in nude mice was 100%. CONCLUSION: A new human endometrial carcinoma, EAC, is established successfully, which is helpful for the basic and clinical study of endometrial carcinoma.

OBJECTIVE: To investigate the distribution and descriptions of the common antigens of allergic rhinitis occurred in the population of Kunshan district so as to provide evidence for clinical diagnosis,treatment and prevention. METHOD: Eight hundred and twenty allergic rhinitis patients were examined skin prick test (SPT) with 18 kinds of antigen extract of allergic rhinitis. RESULT: Six hundred and ninety-four (84.6%) cases were detected at least one antigen, 581 (83.7%) cases were detected two or more antigens. The most common antigens among all the positive cases of skin prick tests were dust mite 492 (70.9%), house dust mite 473 (68.2%), crab 32 (4.5%) and egg white 26 (3.7%). CONCLUSION Mite, crab and egg white are the most common antigens of allergic rhinitis in Kunshan. SPT is important for the diagnosis, treatment and prevention.
Adolescent ; Adult ; Aged ; Allergens ; analysis ; immunology ; Animals ; Child ; China ; epidemiology ; Female ; Humans ; Male ; Middle Aged ; Mites ; immunology ; Rhinitis, Allergic, Perennial ; epidemiology ; Skin Tests ; Young Adult

Objective:To investigate the correlation between serum high sensitivity C-reactive protein and carotid intima-media thickness.Methods:A total of 5 136 health examination subjects, aged ≥40 years old, who met the inclusion criteria and had complete data, were selected as the research objects.A unified questionnaire survey, blood biochemistry and carotid artery color doppler ultrasound examination were performed.According to the diagnostic criteria of hs-CRP published by American Heart Association (AHA), the subjects were divided into three groups: 0.05 mg/L0.84 mm group.The results showed that when the concentration of hs-CRP was high, CIMT increased with the increase of hs-CRP( OR(95% CI) 1.24 (1.01~1.52), P<0.05). Conclusion:There was a positive correlation between hs-CRP and CIMT.Patients with higher levels of hs-CRP are more likely to develop CIMT thickening and increase the risk of arteriosclerotic disease.

Objective: To explore the relationship between longitudinal trajectory of systolic blood pressure (SPB) and atrial fibrillation (AF) in Kailuan group population. Methods: Our study cohort consisted of 40727 participants with the specific criteria in Kailuan group, Tangshan. SAS Proc Traj procedure was used to identify longitudinal trajectories of SPB throughout 2006-2007, 2008-2009 and 2010-2011. There were 5 longitudinal trajectories generated: Low-stable group,n=10950, Moderate-stable group, n=19158, Moderate-high stable group,n=3713, High-moderate stable group,n=4702 and High stable group,n=2181. Log-rank test was performed to compare AF incidence throughout 2012-2013 and 2014-2015 by physical examination among different groups; Multi Cox regression analysis was conducted to study the relationship among different SBP longitudinal trajectories and AF occurrence. Results:①The mean age of participants was (51.81±11.54) years including 30693 (75.4%) male.②AF occurrence rates in Low-stable, Moderate-stable, Moderate-high stable, High-moderate stable and High stable groups were 0.1%, 0.2%, 0.5%, 0.5% and 0.6% respectively, allP<0.05.③Multi Cox regression analysis presented that with adjusted confounding factors, compared with the patients in Low-stable group, Moderate-high stable, High-moderate stable and High stable SBP longitudinal trajectories were the risk factors for new AF occurrence (HR=7.58, 95% CI 2.08-27.73), (HR=5.30, 95% CI 1.88-14.95) and (HR=8.52, 95% CI 1.96-37.09) respectively, allP<0.05. With excluded history of myocardial infarction/stroke, the sensitivity study showed the similar result with the major research trend. Conclusion: Elevated long trajectory of SPB was the risk factor for new AF occurrence in Kailuan group population.

Objective: To explore the predictive value of inlfammatory factors on all cause mortality in normal population.
Methods: In our prospective cohort study, a total of 83,228 subjects from physical examination of Kailuan group from 2006-07 to 2007-10 were enrolled, nobody had acute inlfammation. The death information was collected once per year and the last follow-up was conducted in 2013-12-31. According to baseline levels, white blood cells (WBC), ratio of neutrophil/lymphocyte ratio (N/L) and C-reactive protein (CRP) were respectively divided into 4 Quartile groups; all cause mortality was compared among different groups and their risks were studied by multi-Cox regression analysis.
Results: The average follow-up time was 6.9 years. All cause mortality in Quartile 1, Quartile 2, Quartile 3 and Quartile 4 groups for WBC were 4.2%, 4.5%, 4.5% and 5.0% respectively; for N/L were 3.3%, 3.6%, 4.5% and 6.7% respectively; for CRP were 3.0%, 3.6%, 4.8% and 6.8% respectively. Multi-Cox regression analysis indicated that with adjusted age, gender, waist and other confounders, by elevation of WBC, N/R and CRP, the risks of all cause mortality were increased accordingly, and the risks in Quartile 4 groups were higher than those in Quartile 1 groups as for WBC, it was 1.17-time (95% CI 1.06-1.29);for N/L, it was 1.44-time (95% CI 1.31-1.59); for CRP, it was 1.33-time (95% CI 1.20-1.47) respectively.
Conclusion: Elevated WBC, N/R and CRP are independent risk factors for all cause mortality in normal population.